From the Ghost in the Box to
Successful Biofeedback Training
Biofeedback is our reflection in the mirror. It is a tool for change, a way of developing the potential that is ours. The magic, the “spirit” is not in the machine, it is within us, within the self of self-regulation.
“Biofeedback: Steering by a Star.”
Steven Fahrion, Ph.D., Presidential
Address, Biofeedback Society of
In the preceding chapters we have examined in detail the conceptualizations, models, research methodologies and results of the ghost in the box approaches to biofeedback training and the mastery approaches to biofeedback training. We have seen that in many instances these approaches are diametrically opposed and have no relationship to each other, in spite of the common use of the term “biofeedback.” How did this split occur? Why were the appropriate conceptualizations of the biofeedback instrument as a mirror, and biofeedback training as a process of learning a complex self regulation skill, not adopted and used as a research model?
In our review of both theoretical papers and research reports we find that the chief proponents of the official doctrine were trained in the operant conditioning models and methodologies. Some of these researchers began their careers working with laboratory animals, and none were originally clinicians. This initial training undoubtedly provided a familiar framework for understanding the new phenomena of biofeedback training. The comfort of familiar models is known to us all. The danger of committing category mistakes, however, is directly related to our commitment to familiar models.
The work of Miller and DiCara (1971) showing that curarized
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rats could be operantly conditioned to change a variety of autonomic nervous system functions automatically led to the use of a similar model with humans. Furthermore, the belief that the only rigorous scientific methodology is the isolation of the effects of the “independent variable” led to the belief that biofeedback must have demonstrable specific effects. So passionate is this belief that Hatch (1982) claimed that in biofeedback research we are “uniquely blessed” because there is an independent variable, the contingency, that can be isolated and studied. And perhaps many experimental psychologists were attracted to biofeedback because the use of instrumentation provided an opportunity to collect “hard data” on a new and interesting process. The attractiveness and concreteness of the data may also have shielded these researchers from taboo, “mentalistic,” concepts and from confronting the subject of mind and its interaction with body. But for whatever reason, official doctrine researchers retreat to their models for research methodology even when they have glimpses of more appropriate conceptualizations and more important issues in biofeedback training than isolating specific effects and controlling for the “placebo effect.”
The work of Neal Miller is an example. In the same article in which Miller (1976) uses the analogy of removing a blindfold from a basketball player to describe biofeedback, he relies on his familiar models to discuss appropriate research. Contradicting his own analogy, he warns researchers to beware of the enthusiasm of both the doctor and the patient and writes: “Thus, a stable baseline before training be8ins cannot be used to rule out the placebo effect unless both the experimenter and the patients are unaware of when the training begins” (Miller, 1976). Instead of exploring a sports training model, Miller replaces the blindfolds. His concern with the placebo effect replaces his concern for learning through feedback of information.
Official doctrine researchers adopted the well established and extremely simple conceptualizations of drug and animal research. Along with the concepts from drug and anal research came the language, the methods and most importantly, the goals of these fields. The early focus on voluntary self regulation and human potential for self mastery was disregarded in much of the research. Instead, the inherently minimal goals of animal and drug research
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were accepted for humans in “bare bones” biofeedback training. The tacit acceptance of such goals enabled the errors described in Chapter 2 to persist in biofeedback research.
In contrast, to understand the new process called “biofeedback,” several pioneers knew that conceptualizations for understanding this process should be based on those areas of human experience in which high levels of performance had already been demonstrated, such as the Science of Yoga. Adept yogis have demonstrated unusual levels of self mastery. It was of interest then to study the skills of yogis and to attempt to understand the conceptualizations of Yoga. Several early pioneers of biofeedback training studied unusual people and traveled to India in search of yogis who could demonstrate their powers and in search of conceptualizations with which to understand and develop biofeedback training, (Elmer and Alyce Green, Erik Peper and Gay Luce, and Barbara Brown).
These investigations expanded our horizons and supported the growing awareness that humans have extraordinary potential for voluntary psychophysiological self regulation and health. It was clear that biofeedback training could be a method for the investigation of this potential and a tool for the enhancement of this potential for health. Concepts appropriate to voluntary self regulation were discussed early in the development of biofeedback training by these researchers: consciousness, “self awareness”, “motivation,” and “volition.” In Beyond Biofeedback the Greens (1977) devote an entire chapter to the concept of volition and discuss at length the model of biofeedback as consciousness training. Such concepts are familiar to many researchers and clinicians who use the expression “voluntary self regulation” literally, and who are involved in the exploration and development of the processes of psychophysiological self regulation.
These contradictory approaches to biofeedback training give strikingly different meanings to the term “biofeedback training. As we have described in this monograph, one use of the term refers to bare-bones, trial-and-error, unsystematic biofeedback and the other refers to systematic biofeedback training, meaning that in conjunction with feedback, a systematic training procedure is used such as “autogenic feedback training.” These distinctly different meanings have led to confusion and conflict. For example, when
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a clinician uses the term “biofeedback training” in a single case report, this refers to systematic feedback training. But the editors and reviewers of the report may have the bare-bones concept in mind and believe that this is the only appropriate methodology with which biofeedback can be studied. Consequently the report will be rejected for publication, being called “anecdotal” or “confounded” or “not a significant contribution to the literature.” The term “psychophysiological feedback training” more accurately describes the process that is called “biofeedback training” by taking into account the impact of mind on body, and recognizing that the biofeedback instrument reflects the physiological change that results from changes in both physiological and psychological processes. The Menninger Foundation team refers to their work as psychophysiological therapy, not biofeedback therapy. In fact, because “biofeedback therapy” includes cognitive, behavioral and physiological training to achieve the goal of self regulation or mastery, in all domains, a more inclusive term is “self regulation therapy.” The use of biofeedback instrumentation is one element in self regulation therapy.
A misleading implication of the term “biofeedback training” is that the use of biofeedback equipment is the training. This is like saying “stop-watch training.” Athletic training is not labeled in this way because although the stop watch is useful, or even essential, in providing information, it is not a training technique in itself. In the same way, although the biofeedback instrument is useful, and perhaps at times essential, because it provides information, it is not a training technique. Thus the term “biofeedback training” is misleading and the correct term to describe the process is “self regulation training assisted by biofeedback instrumentation.” Pole vault training, however, is an accurate description of that process because the pole is essential for the activity.
The term “biofeedback training” is useful only when it means training, with the aid of biofeedback instrumentation. Because the terms “biofeedback,’ “biofeedback training,” and “biofeedback therapy” are part of our common language,, however, we will continue to use these terms to describe our work. We propose that in the future, the process being used should be referred to as “Unsystematic biofeedback training” or “systematic biofeedback train-
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ing.” Unsystematic biofeedback training will describe the bare-bones or trial-and-error training procedures of the operant conditioning-drug effects model, and systematic biofeedback training, or biofeedback therapy, will refer to the use of the mastery model.
We have seen that, in essence, the drug and operant conditioning models of the official doctrine do not view biofeedback training as a tool for learned self regulation, and do not facilitate learned self regulation through the research methodologies of the models. These research methodologies attempt to study biofeedback in isolation. On the other hand, the mastery model, in essence, is a learning model, and promotes learning in psychophysiological, cognitive, and behavioral domains. This model includes the use of many training techniques, and biofeedback instrumentation as a tool for learning.
Are the machines necessary? Sometimes, but not always. A biofeedback instrument is not essential for learning relaxation and for experiencing the benefits of relaxation skills, such as symptom and medication reduction. Relaxation is powerful, and if successfully learned and practiced, healthy homeostasis is enhanced. The fact that the basic elements of the mastery model are used in the treatment of a variety of disorders is evidence of the ability of mind and body to return to healthy homeostasis.
But knowledge is power, and while there is no ghost in the machine, the feedback of information from the biofeedback instrument is of value to most trainees and is essential for some. The feedback of psychophysiological information is an ingredient in self regulation training that hastens learning by removing blindfolds and by confirming self regulation strategies. In some cases, the information is so helpful that the trainee appears to be an instant learner. Ultimately, because there is no ghost in the box, the trainee dispenses with the use of the biofeedback instrument. This happens when the trainee has learned to identify and voluntarily create the desired psychophysiological response that the machine reflects. This is the goal of self regulation therapy.
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Self Regulation Training
A research and clinical model appropriate to the exploration and development of human potential for self regulation must be derived from conceptualizations and models of learning that allow exploration of all possible avenues for maximizing change. Unlike the self-limiting concepts and models that led to Category Mistakes #1 and #2, the mastery model, in which training to mastery is maximized and demonstrated, is nonlimiting. As described in detail in Chapter 4, this training model incorporates appropriate instructions by an experienced trainer, progressive, and well defined goals, consistent long-term practice, adjunctive skills training, positive self talk, positive imagery, feedback enhanced consciousness, motivation and drive (volition), and a healthy lifestyle.
If the mastery model is adopted, research issues and methodology will dramatically change:
(1) The assumptions of reductionism and parsimony would not be scientifically useful—instead of stripping away the synergy of powerful multicomponent training methods and developing artificial “bare-bones” treatment, studies would be designed to maximize mastery.
(2) Simplistic models of learning based on laboratory animal research would be replaced with models of human learning. More appropriate models are Hyland’s concept of person variables (1985), McClelland’s theory and research on human motivation (1984), and the work of Lazarus (1975) and Meichenbaum (1976).
(3) Mastery criteria would be established for different diseases and patient variables such as age, medication use, and health habits. An important task would be to develop laboratory stressors that are effective for testing self regulation skills and for transferring these skills to the every day stressors of frustration, performance anxiety, interpersonal conflict, and life change.
(4) Training would continue to mastery.
(5) Training data would be reported and these data would be correlated with treatment effects.
(6) The function of control groups would be to compare efficacious treatments, for example, comparing a phar-
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macological group to a clinical biofeedback treatment group. In addition, single case studies and group outcome studies would be valid without “official doctrine” controls because each patient acts as his/her own control.
(7) Treatment outcome variables would include reduction in the presenting symptom, reduction in secondary symptoms, medication reduction, improved quality of life and cost effectiveness.
(8) Individual differences in physiology, training needs and learning styles would be emphasized. A research and statistical model incorporating individual differences would be developed such as that recommended by Banderia et al (1982), and Perez and Brown, (1985). A time series design methodology would be used to accurately assess individual change scores over time.
(9) New relaxation techniques would be created.
(10) Methods for motivating subjects and ensuring compliance with the training protocol would be developed.
(11) Personal learning strategies and subjective reports would be elicited as an aid to training and research.
(12) Creativity and funding would be devoted to the development of new technology for monitoring physiological processes that are still “blindfolded” such as ocular pressure, blood sugar and kidney function.
(13) The neurophysiology of stress, relaxation, hope and expectation would be studied.
We have no illusions about the difficulty of researching a process as complex as psychophysiological self regulation. The difficulty lies in the complexity of mind/body interaction, and in changing entrenched models and methodologies. Yet there are exciting horizons to explore in our ability to self regulate mind and body for health.
We anticipate that the errors that arose from inadequate conceptualizations and models of biofeedback training can be put aside, and that appropriate models and methodologies as described in this monograph can be developed, and will expand the horizons of self regulation training and treatment.
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The advent of biofeedback instrumentation is truly momentous. Psychophysiological information previously unavailable to consciousness is made available for the first time in human history. Systematic biofeedback training, or biofeedback therapy as we often refer to the process, is unique. Unlike drugs and other manipulations, the therapeutic goal is masterful self regulation and the modus operandi is learning, facilitated by the feedback of information.
Although feedback of information is essential for learning, the information itself, and the instrument providing the information, have no inherent power to create psychophysiological change in humans. Research based on the belief of inherent power (Category Mistake #1) often fails because the assumption is false and methodological errors based on the false assumptions (i.e. minimal training) limit learning and self regulation. The power of the process, systematic biofeedback training, is determined solely by the user. If the user is assumed to have the learning characteristics of laboratory animals (Category Mistake #2) then biofeedback research based on this assumption often fails because the assumption is false and methodological errors based on this false assumption (i.e. no homework) limit learning and self regulation.
We propose that after 17 years of research, it is time to ask:
“How can we maximize our potential for self regulation, symptom reduction, and enhanced quality of life through systematic biofeedback training?”
As we address this question, the conceptualizations about human learning that must inevitably evolve will be complex, and the elucidation of the dynamics of psychophysiological self regulation will be difficult. The challenge will be to discard simplistic models and simplistic “scientific” research methodology. If we must attempt to isolate the mechanisms of this process through research, let us at least avoid methodology that kills the process that we are attempting to study—so that it will not be metaphorically said of our science, “the operation was a success but the patient died.”
We look forward to renewed excitement and energy in the field of biofeedback training, as researchers and clinicians work together
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from a strong foundation of shared conceptualizations and models, and a shared interest in exploring the dimensions of conscious self regulation in humans.
[End of Chapter 6]
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This internet publication of the historic monograph “From the Ghost in the Box to Successful Biofeedback Training” is itself an historic event — the first known publication of a masterpiece previously-published document as “shareware”.
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